Does health insurance matter in antenatal care experience? A study among expectant mothers at a federal medical centre in Nigeria

One of the viable ways of improving accessibility to maternal health services and Antenatal Care (ANC) is through health insurance. The National Health Insurance Scheme (NHIS) in Nigeria has the objective of promoting access to quality healthcare, which includes maternity care amongst other services. A descriptive cross-sectional study was done between August and September 2017 to evaluate the perception and satisfaction of insured (NHIS) and uninsured (Out-of-Pocket paying) pregnant women with the quality of antenatal care services at the Federal Medical Centre- Keffi, Nasarawa state, Nigeria, and to also identify if health insurance has any influence on the antenatal care experience. Data were collected from 85 respondents from each group through interviewer-administered questionnaires, containing socio-demographic and obstetric characteristics, knowledge on ANC, satisfaction with antenatal care services and perception about the NHIS and out-of-pocket payment. Data analysis was done using IBM SPSS Statistics 20.0. The mean gestational age at booking for insured enrollees (16.5 ± 4.3 weeks) was significantly lower than that of uninsured patients (20.3 ± 5.8 weeks), p-value = 0.001. There were some significant differences in the specific aspects of services accessed, however, the overall mean satisfaction for the uninsured group was 80.4 ± 7.5 while that of the insured group was 82.1 ± 5.9, with the difference not statistically significant, p-value: 0.057. Majority of the insured 69(81.2%) and uninsured 60(70.6%) patients indicated preference for the insurance system. This study found that overall, insured and uninsured pregnant women generally expressed comparable levels of satisfaction, and it also indicated the need for service improvement and expansion. Efforts and advocacy should be strengthened therefore, towards increasing health insurance coverage and improving its services.Keywords: Antenatal care, Perception, Satisfaction, Quality of care, Health insurance, NigeriaSavannah Journal of Medical Research and Practice 2018; 7(1):07-16